Provider Demographics
NPI:1518921360
Name:BARAKAT, BSHARA J (MD)
Entity Type:Individual
Prefix:
First Name:BSHARA
Middle Name:J
Last Name:BARAKAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 OAK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4410
Mailing Address - Country:US
Mailing Address - Phone:904-389-2707
Mailing Address - Fax:904-389-7009
Practice Address - Street 1:2119 OAK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4410
Practice Address - Country:US
Practice Address - Phone:904-389-2707
Practice Address - Fax:904-389-7009
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68949174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271973800Medicaid
FLG15504Medicare UPIN
FL27760YMedicare ID - Type Unspecified